Isiphumo sonyango sixhomekeke kwi-anatomical repositioning yebhloko ye-fracture, ukulungiswa okunamandla kwe-fracture, ukugcinwa kokugubungela kakuhle kwezicubu ezithambileyo kunye nokusebenza kwangaphambili kokusebenza.
I-Anatomy
Ii-humer ekudeihlulwe ibe yikholomu ephakathi kunye nekholamu esecaleni (Umfanekiso 1).
Umzobo 1 I-distal humerus iqukethe ikholomu ephakathi kunye necala
Ikholamu ephakathi iquka inxalenye ephakathi ye-humeral epiphysis, i-epicondyle ye-humerus kunye ne-condyle ye-humeral ephakathi kuquka i-humeral glide.
Ikholamu esecaleni equka inxalenye yecala le-humeral epiphysis, i-epicondyle yangaphandle ye-humerus kunye ne-condyle yangaphandle ye-humerus kuquka i-humeral tuberosity.
Phakathi kweekholamu ezimbini ezisecaleni kukho i-coronoid fossa yangaphambili kunye ne-posterior humeral fossa.
Indlela yokwenzakala
I-Supracondylar fractures ye-humerus idla ngokubangelwa ukuwa kwiindawo eziphakamileyo.
Izigulana ezincinci ezine-intra-articular fractures zihlala zibangelwa kukulimala kobundlobongela obunamandla, kodwa izigulana ezindala zinokuba ne-intra-articular fractures ezivela kwi-low-energy fractures ngenxa ye-osteoporosis.
Ukuchwetheza
(a) Kukho i-supracondylar fractures, i-condylar fractures kunye ne-intercondylar fractures.
b
(c)Ihumeral condylar fracture: indawo yokwaphuka ikwifossa yehawk.
(d) i-intercondylar fracture ye-humerus: indawo yokuphuka ibekwe phakathi kwee-distal condyles ze-humerus.
Umzobo 2 AO ukuchwetheza
I-AO yokuchwetheza i-humeral fracture (Umfanekiso 2)
Uhlobo A: iifractures ezongeziweyo.
Uhlobo B: i-fracture ebandakanya i-articular surface (i-fracture yekholomu enye).
Uhlobo C: ukuhlukana okupheleleyo kwe-articular surface ye-distal humerus ukusuka kwi-humeral stem (i-bicolumnar fracture).
Uhlobo ngalunye luphinde lwahlulwe lwaba zii-subtypes ezi-3 ngokwenqanaba lokuhamba kokwaphuka, (i-1 ~ 3 subtypes kunye neqondo elikhulayo lokuhamba ngaloo ndlela).
Umzobo3 Ukuchwetheza kweRiseborough-Radin
I-Riseborough-Radin ukuchwetheza i-intercondylar fractures ye-humerus (zonke iintlobo ziquka inxalenye ye-supracondylar ye-humerus)
Uhlobo I: ukuphuka ngaphandle kokufuduka phakathi kwe-humeral tuberosity kunye ne-talus.
Uhlobo lwe-II: i-intercondylar fracture ye-humerus kunye nokufuduka kobunzima bokuphuka kwe-condyle ngaphandle kokukhubazeka okujikelezayo.
Uhlobo lwe-III: i-intercondylar fracture ye-humerus kunye nokufuduka kweqhekeza leqhekeza le-condyle kunye nokukhubazeka okujikelezayo.
Uhlobo lwe-IV: ukuphuka okukhulu kwe-articular surface ye-condyles enye okanye zombini (Umfanekiso 3).
Umfanekiso we-4 Uhlobo lwe-I ye-humeral tuberosity fracture
Umzobo we-5 I-humeral tuberosity fracture staging
Ukuqhekeka kwe-humeral tuberosity: ukwenzakala kwe-shear ye-distal humerus
Uhlobo lwe-I: ukuphulwa kwe-tuberosity yonke ye-humeral kuquka i-lateral edge ye-humeral talus (i-Hahn-Steinthal fracture) (Umfanekiso 4).
Uhlobo lwe-II: i-subchondral fracture ye-articular cartilage ye-humeral tuberosity (i-Kocher-Lorenz fracture).
Uhlobo lwe-III: ukuphulwa kwe-fracture ye-humeral tuberosity (Umfanekiso 5).
Unyango olungasebenzisiyo
Iindlela zonyango ezingasebenziyo kwi-distal humeral fractures zinendima elinganiselwe.Injongo yonyango olungasebenzisiyo kukuba: ukunyakaza kwamalungu kwangoko ukuphepha ukuqina kwamalungu;izigulane ezisebekhulile, ezijongene nezifo ezininzi ezidibeneyo, kufuneka ziphathwe ngendlela elula yokuqhawula i-elbow joint kwi-60 ° ye-flexion kwiiveki ze-2-3, ilandelwa ngumsebenzi wokukhanya.
Unyango lotyando
Injongo yonyango kukubuyisela uluhlu olungasebenziyo lwentlungu yokunyakaza kokubambisana (i-30 ° yokwandiswa kwe-elbow, i-130 ° ye-elbow flexion, i-50 ° yokujikeleza kwangaphambili nasemva);ukulungiswa kwangaphakathi okuqinileyo kunye nokuzinzile kwe-fracture kuvumela ukuqala kokuzivocavoca kwe-elbow esebenzayo emva kokuphulukiswa kwesilonda sesikhumba;ukulungiswa kwepleyiti ephindwe kabini ye-distal humerus ibandakanya: i-medial kunye ne-posterior lateral double plate fixation, okanyeiphakathi kunye necalaukulungiswa kwepleyiti kabini.
Indlela yotyando
(a) Isigulane sibekwe kwindawo esecaleni ephezulu kunye nomgca obekwe phantsi kwelungu elichaphazelekayo.
ukuchongwa kunye nokukhuselwa kwe-nerve median kunye ne-radial intraoperatively.
Ingqiniba yangasemva inokwandiswa ufikelelo lotyando: i-ulnar hawk osteotomy okanye i-triceps retraction ukuze iveze iifracture ezinzulu zearticular.
i-ulnar hawkeye osteotomy: ukuvezwa okwaneleyo, ngakumbi kwiifractures ezidibeneyo zomphezulu we-articular.Nangona kunjalo, i-fracture non-union ihlala isenzeka kwindawo ye-osteotomy.Izinga lokuqhekeka kwe-non-union liye lancitshiswa kakhulu ngokuphuculwa kwe-ulnar hawk osteotomy (i-herringbone osteotomy) kunye ne-transtension band wire okanye ukulungiswa kweplate.
Ukuvezwa kwe-Triceps okurhoxiswayo kunokufakwa kwi-distal humeral trifold fractures block with joint comminution, kunye nokuvezwa okwandisiweyo kwesilayidi se-humeral kunokusika kwaye kuveze incam ye-ulnar hawk malunga ne-1 cm.
Kufunyenwe ukuba iiplati ezimbini zingafakwa nge-orthogonally okanye ngokufana, kuxhomekeke kuhlobo lokuphuka apho iiplate kufuneka zibekwe khona.
Iifractures ze-articular surface kufuneka zibuyiselwe kwindawo ye-articular flat kwaye igxininiswe kwi-humeral stem.
Umzobo 6 Ukulungiswa kwangaphakathi kwangaphakathi emva kokuphuka kwe-elbow
Ukulungiswa kwexeshana kwebloko lokuqhekeka kwenziwa ngokufaka ucingo lwe-K, emva koko i-3.5 mm ipleyiti yokunyanzeliswa kwamandla yalungiswa kwimilo yeplate ngokwemilo esemva kwekholamu yecala le-distal humerus, kunye ne-3.5 mm ipleyiti yokuvuselela amandla. ilungisiwe kwimilo yekholamu ye-medial, ukwenzela ukuba amacala omabini epleyiti afane nomphezulu wethambo (ipleyiti entsha yokubunjwa kwangaphambili inokwenza lula inkqubo.) (Umfanekiso 6).
Qaphela ukuba ungalungisi i-articular surface fracture fragment with all-threaded cortical screws kunye noxinzelelo olusuka kwi-medial ukuya kwicala elisecaleni.
indawo ye-epiphysis-humerus yewaka lokufuduka ibalulekile ukuphepha ukungabikho komanyano lokuqhekeka.
ukunika i-bone graft filling kwindawo yesiphene samathambo, ukusebenzisa i-iliac cancellous bone grafts ukuzalisa i-compression fracture defect: ikholamu ye-medial, i-articular surface kunye nekholamu esecaleni, ukudibanisa ithambo lokukhansela kwicala kunye ne-periosteum engaguqukiyo kunye ne-compression bone defect kwi-epiphysis.
Khumbula iingongoma eziphambili zokulungisa.
Ukulungiswa kweqhekeza le-distal fracture kunye nabaninziizikrufukangangoko kunokwenzeka.
ukulungiswa kwamaqhekeza aqhekezayo amaninzi kangangoko kunokwenzeka ngezikrufu ezinqumlayo ukuya ecaleni.
Iipleyiti zensimbi kufuneka zibekwe kumacala aphakathi kunye necala le-distal humerus.
Iinketho zonyango: I-arthroplasty ye-elbow iyonke
Kwizigulane ezineentlungu ezibuhlungu okanye i-osteoporosis, i-arthroplasty epheleleyo ye-elbow inokubuyisela ukunyakaza okuhlangeneyo kwe-elbow kunye nokusebenza kwesandla emva kwezigulane ezingabalulekanga;ubuchule botyando bufana ne-arthroplasty iyonke yotshintsho oluwohlokayo lwe-elbow joint.
(1) ukusetyenziswa kweprothesis yohlobo olude lwe-stem ukuthintela ukwandiswa kwe-fracture ekufutshane.
(2) Isishwankathelo sotyando.
(a) Inkqubo yenziwa ngokusebenzisa indlela ye-elbow yangasemva, kunye namanyathelo afana nalawo asetyenziselwa i-distal humeral fracture incision kunye nokulungiswa kwangaphakathi (ORIF).
I-Anteriorization ye-nerve ye-ulnar.
ukufikelela kumacala omabini e-triceps ukususa ithambo eliqhekezayo (inqaku eliphambili: musa ukusika ukumisa kwe-triceps kwindawo ye-ulnar hawk).
I-humerus yonke ye-distal kuquka i-fossa ye-hawk inokususwa kunye ne-prosthesis efakwe, engayi kushiya nayiphi na i-sequelae ebalulekileyo ukuba i-I eyongezelelweyo ukuya kwi-2 cm isusiwe.
ukulungelelaniswa koxinzelelo lwangaphakathi lwe-triceps muscle ngexesha lokufaneleka kwe-humeral prosthesis emva kokuchithwa kwe-condyle ye-humeral.
Ukukhutshwa kwencam yokuphakama kwe-ulnar esondele kakhulu ukuvumela ukufikelela okungcono kokuvezwa kunye nokufakelwa kwecandelo le-ulnar prosthesis (Umfanekiso 7).
Umzobo 7 I-Elbow arthroplasty
Ukhathalelo lwasemva kotyando
I-postoperative splinting yenkalo yangasemva ye-elbow joint kufuneka isuswe xa isilonda sesikhumba sesigulane siphilisa, kunye nokuzivocavoca okusebenzayo okusebenzayo ngoncedo kufuneka kuqalwe;i-elbow joint kufuneka igxininiswe ixesha elide elaneleyo emva kokutshintshwa okupheleleyo okudibeneyo ukukhuthaza ukuphulukiswa kwenxeba lesikhumba (i-elbow joint inokulungiswa kwindawo ethe tye kwiiveki ezi-2 emva kokuhlinzwa ukunceda ukufumana umsebenzi ongcono wokwandisa);i-splint fixed esuswayo ngoku isetyenziswa ngokuqhelekileyo kwiklinikhi ukuququzelela uluhlu lweendlela zokuzivocavoca xa Inokususwa rhoqo ukuze kukhuseleke kangcono imilenze echaphazelekayo;Umthambo osebenzayo osebenzayo udla ngokuqalwa kwiiveki ezi-6-8 emva kokuba inxeba lolusu liphilisiwe ngokupheleleyo.
Ukhathalelo lwasemva kotyando
I-postoperative splinting yenkalo yangasemva ye-elbow joint kufuneka isuswe xa isilonda sesikhumba sesigulane siphilisa, kunye nokuzivocavoca okusebenzayo okusebenzayo ngoncedo kufuneka kuqalwe;i-elbow joint kufuneka igxininiswe ixesha elide elaneleyo emva kokutshintshwa okupheleleyo okudibeneyo ukukhuthaza ukuphulukiswa kwenxeba lesikhumba (i-elbow joint inokulungiswa kwindawo ethe tye kwiiveki ezi-2 emva kokuhlinzwa ukunceda ukufumana umsebenzi ongcono wokwandisa);i-splint fixed esuswayo ngoku isetyenziswa ngokuqhelekileyo kwiklinikhi ukuququzelela uluhlu lweendlela zokuzivocavoca xa Inokususwa rhoqo ukuze kukhuseleke kangcono imilenze echaphazelekayo;Umthambo osebenzayo osebenzayo udla ngokuqalwa kwiiveki ezi-6-8 emva kokuba inxeba lolusu liphilisiwe ngokupheleleyo.
Ixesha lokuposa: Dec-03-2022
